Methods and devices for providing surgical access through tissue to a surgical site

ABSTRACT

Methods and devices are provided for providing surgical access into a body cavity. A surgical access port is provided that has an adjustable longitudinal length, such as by being formed from multiple segments configured to move relative to one another. An anchor can be coupled to a distal end of the surgical access port to help secure the surgical access port within a tissue opening by engaging a distal side of the tissue. Optionally, the anchor can be removably coupled to the distal end of the surgical access port, thereby allowing any one of a plurality of anchors to be selectively coupled thereto.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is being filed concurrently with U.S.application Ser. No. 12/636,184 entitled “Methods And Devices ForProviding Access Through Tissue To A Surgical Site” and U.S. applicationSer. No. 12/636,191 entitled “Methods And Devices For Providing AccessThrough Tissue To A Surgical Site”, which are incorporated by referenceherein in their entireties.

FIELD OF THE INVENTION

The present invention relates to methods and devices for providingaccess through tissue to a surgical site.

BACKGROUND OF THE INVENTION

Access ports are widely used in medical procedures to gain access toanatomical cavities ranging in size from the abdomen to small bloodvessels, such as veins and arteries, epidural, pleural and subarachnoidspaces, heart ventricles, and spinal and synovial cavities. The use ofaccess ports has become more common as they provide minimally invasivetechniques for establishing a portal for a number of procedures, such asthose involving the abdominal cavity.

A trocar is one type of access post that is commonly used to provide aminimally invasive pathway for accessing a surgical site. Trocarsgenerally include a cutting assembly or obturator that is disposedwithin an outer cannula. The sharp distal end of the cutting assembly,with the cannula disposed therearound, is urged through the skin untilit enters the anatomical cavity being penetrated. The cutting assemblyis then withdrawn from the cannula, which remains in place to provide apassageway through which access to the anatomical cavity is provided forother surgical devices, e.g., laparoscopic instruments such as graspers,dissectors, scissors, retractors, etc.

While effective, there can be many disadvantages when using a typicaltrocar assembly. For example, numerous types of procedures using atypical trocar assembly involve insufflation of the abdominal cavitywith CO₂ gas to increase interior space for a surgical procedure. Thisis often achieved using an additional port to allow gas to be passedinto a body cavity to provide pressure therein to maintain insufflationof the cavity. Maintaining insufflation can be difficult because thetrocar can extend a distance above the skin and surface through which itis inserted depending on the length of the trocar, which could create agap through which insufflation fluid can escape. Additionally, thetrocar could move relative to the tissue in which it is inserted, suchas when instruments are inserted therethrough into the cavity, whichcould affect insufflation as well as interfere with proper positioningof the instruments. Insufflation can be made even more difficult beforethe body cavity is inflated as there are organs and other vitalstructures that can be directly adjacent the puncture site where thetrocar assembly is inserted through the tissue, and it is desirable toprevent damage to these structures during insertion of the trocar.

Accordingly, there is a need for improved methods and devices forproviding access through tissue to a surgical site.

SUMMARY OF THE INVENTION

The present invention generally provides methods and devices forproviding access through tissue to a surgical site. In one embodiment, amodular access device is provided that includes a housing having acannula extending distally therefrom, the housing and the cannuladefining a working channel extending therethrough for receiving aninstrument, at least one seal element disposed within the workingchannel and configured to form at least one of a seal around aninstrument disposed through the working channel and a seal across theworking channel when no instrument is disposed therethrough, and ananchor segment removably coupled to a distal end of the cannula.

In some embodiments, the cannula is formed from a plurality of segments,which can be polyaxially coupled to one another.

The anchor segment can have a variety of sizes, shapes, andconfigurations. The anchor segment can have a maximum outer diameterthat is greater than a maximum outer diameter of the cannula. The anchorsegment can optionally have at least one retention thread formed on anouter surface thereof In some embodiments, the anchor segment can bemovable between a first configuration in which the anchor segment has afirst outer diameter and a second configuration in which the anchorsegment has a second outer diameter that is greater than the first outerdiameter. The anchor segment can be configured to move between the firstconfiguration and the second configuration upon rotation of a distal endof the anchor segment. An engagement feature can be formed within theanchor segment and be configured to couple to a complementary engagementfeature on an obturator. At least a portion of the anchor segment can beconfigured to collapse when the anchor segment moves from the firstconfiguration to the second configuration. In some embodiments, theanchor segment can include a plurality of flexible wires spacedlongitudinally apart from one another and configured to collapse whenthe anchor segment moves from the first configuration to the secondconfiguration. A sleeve can be disposed over the plurality of flexiblewires.

In another embodiment, a modular access device is provided that includesa housing having a cannula extending distally therefrom, the housing andthe cannula defining a working channel extending therethrough forreceiving an instrument. The cannula includes a plurality of segmentsremovably coupled to one another. When the plurality of segments aremated, the plurality of segments are movable toward and away from oneanother along a longitudinal axis of the working channel to allow alength of the cannula to be adjusted. In some embodiments, the cannulacan have a scallop-shaped external surface.

The modular access device can also include at least one seal disposedwithin the working channel and configured to form at least one of a sealaround an instrument disposed through the working channel and a sealacross the working channel when no instrument is disposed therethrough.In some embodiments, an anchor segment can be attached to a distal-mostend of the cannula. The anchor segment can have a maximum outer diameterthat is greater than a maximum outer diameter of the cannula.

The plurality of segments can have a variety of sizes, shapes, andconfigurations. For non-limiting example, the plurality of segments canbe polyaxially coupled to one another and/or be mated to form a fluidtight seal therebetween. In some embodiments, each segment can include abiasing element and/or a flexion region. The biasing element can biasthe plurality of segments toward one another. Each segment can include abore formed therein, and the biasing element can include at least oneradially-extending deflectable flange configured to engage the bore. Theflexion region can be configured to allow a longitudinal length of thesegment to be adjusted. In some embodiments, one of the plurality ofsegments can be removably coupled to the housing.

In another embodiment, a modular access device includes a housing havinga cannula extending distally therefrom, the housing and the cannuladefining a working channel extending therethrough. The cannula includesa plurality of segments movably coupled to one another. Each segment hasa male member and a female member, and each segment includes a biasingfeature that biases the male and female members into engagement with oneanother.

The modular access device can vary in any number of ways. The pluralityof segments can be movable toward and away from one another when thesegments are mated to allow a length of the cannula to be adjusted. Amating connection between each of the plurality of segments can form afluid tight seal. The plurality of segments can be polyaxially coupledto one another.

The male and female members can each have a variety of sizes, shapes,and configurations. The male member can be configured to mate to thefemale member by snap-fit. The female member can optionally include anexpandable opening. The female member can include a bore, and thebiasing feature can include at least one radially-extending deflectableflange formed on the male member and configured to engage the bore. Insome embodiments, the male member can include a ball, and the femalemember can include a socket.

In another aspect, a modular access system is provided that includes ahousing configured to be positioned above an outer surface of a tissue,a cannula extending distally from the housing and configured to extendthrough an opening in the tissue, and a plurality of anchors ofdiffering configurations. Each anchor is removably matable to a distalend of the cannula. The cannula can optionally be formed from aplurality of segments.

The modular access system can include any number of other components,such as at least one seal disposed within at least one of the housingand the cannula, with the at least one seal being configured to form atleast one of a seal around an instrument disposed through the accessdevice and a seal within the access device when no instrument isdisposed therethrough. For another non-limiting example, the modularaccess system can include an obturator disposable through the housingand the cannula. At least one of the plurality of anchors can have anengagement feature formed therein, and the obturator can have as anengagement feature formed thereon and configured to mate with theengagement feature on the anchor. The obturator can optionally have atransparent distal tip.

In some embodiments, the anchor can be movable between a firstconfiguration in which the anchor has a first outer diameter and asecond configuration in which the anchor has a second outer diameterthat is greater than the first outer diameter. The anchor can be movedbetween the first and second configurations in a variety of ways. Forexample, an obturator disposable through the housing and the cannula canbe configured to rotate about a longitudinal axis of the obturator tomove the anchor from the first configuration to the secondconfiguration.

In another aspect, a surgical access device is provided that includes ahousing having a cannula extending distally therefrom, and an adjustmentmechanism coupled to the housing. The housing and the cannula define aworking channel extending therethrough for receiving an instrument. Thecannula is movable between an insertion configuration and a deployedconfiguration, and a biasing force biases the cannula to the deployedconfiguration. The adjustment mechanism is configured to adjust thebiasing force.

The cannula can have a variety of sizes, shapes, and configurations. Fornon-limiting example, in the insertion configuration, the cannula canhave a length that is greater than a length of the cannula in thedeployed configuration and/or have a maximum outer diameter that isgreater than a maximum outer diameter of the cannula in the deployedconfiguration. For another non-limiting example, the cannula can includea plurality of segments movably coupled to one another. In someembodiments, the adjustment mechanism can be selectively rotatablerelative to the housing to adjust the biasing force. The cannula canoptionally include a distal-most anchor, and rotation of the adjustmentmechanism can be effective to expand the distal-most anchor.

The surgical access device can include any one or more additionalcomponents, such as a biasing element coupled to the cannula andconfigured to apply the biasing force to the cannula. The biasingelement can include at least one cable extending through the cannula.The adjustment mechanism can be configured to adjust a length of the atleast one cable to adjust the biasing force. For another non-limitingexample, the surgical access device can include at least one sealelement disposed within the working channel and configured to form atleast one of a seal around an instrument disposed through the workingchannel and a seal across the working channel when no instrument isdisposed therethrough.

In another embodiment, a surgical access device is provided thatincludes a housing having a cannula extending distally therefrom. Thehousing and the cannula define a working channel extending therethroughfor receiving an instrument, and the cannula is movable between aninsertion configuration and a deployed configuration. At least onebiasing element coupled to the cannula is configured to apply a biasingforce to the cannula to bias the cannula to the deployed configuration.An adjustment mechanism operatively coupled to the at least one biasingelement is configured to adjust the biasing force. Optionally, theadjustment mechanism can be selectively rotatable relative to thehousing to adjust the biasing force, and/or at least one seal elementcan be disposed within the working channel and be configured to form atleast one of a seal around an instrument disposed through the workingchannel and a seal across the working channel when no instrument isdisposed therethrough.

The cannula can have a variety of sizes, shapes, and configurations. Thecannula can include a plurality of segments movably coupled to oneanother. In the insertion configuration, the cannula can have a lengththat is greater than a length of the cannula in the deployedconfiguration and/or have a maximum outer diameter in the insertionconfiguration that is greater than a maximum outer diameter of thecannula in the deployed configuration. In some embodiments, the cannulacan include a distal-most expandable anchor. The distal-most expandableanchor can moves from an insertion configuration to an expandedconfiguration when the cannula is moved from the insertion configurationto the deployment configuration.

In some embodiments, the biasing element can include at least one cableextending through the cannula. The adjustment mechanism can beconfigured to adjust a length of the at least one cable to adjust thebiasing force.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a side view of one embodiment of a surgical access devicehaving a housing with a cannula distally extending therefrom, thecannula including a plurality of segments movably and removably coupledto one another and having an anchor at a distal end thereof, and a sideview of one embodiment of an obturator receivable in a working channelof the surgical access device;

FIG. 2 is a side cross-sectional view of the surgical access device ofFIG. 1;

FIG. 3 is a side cross-sectional view of one of the segments of FIG. 1;

FIG. 4 is a side cross-sectional view of another embodiment of asegment;

FIG. 5 is a side, cross-sectional, partial view of another embodiment ofa cannula including a plurality of segments movably and removablycoupled to one another, the cannula being in a curved position;

FIG. 6 is a side view of the anchor of FIG. 1;

FIG. 7 is a side cross-sectional view of the anchor of FIG. 1 with theanchor in an undeployed configuration and with the obturator of FIG. 1being inserted into the anchor;

FIG. 8 is a side cross-sectional view of the anchor and the obturator ofFIG. 7 with the obturator keyed to the anchor and with the anchor in adeployed configuration;

FIG. 9 is a perspective, partially transparent view of the anchor ofFIG. 8 in the deployed configuration;

FIG. 10 is a side cross-sectional view of the anchor of FIG. 8 in thedeployed configuration with the obturator removed therefrom;

FIG. 11 is a side view of another embodiment of an anchor including aplurality of spiraling flexible wires, the anchor being in an undeployedconfiguration;

FIG. 12 is a top view of the anchor of FIG. 11 with the anchor in adeployed configuration;

FIG. 13 is a side cross-sectional view of the anchor of FIG. 12;

FIG. 14 is a side cross-sectional view of another embodiment of ananchor including a plurality of wide flexible wires, the anchor being inan undeployed configuration;

FIG. 15 is a perspective cross-sectional view of the anchor of FIG. 14in a deployed configuration;

FIG. 16 is a side, partially transparent view of the anchor of FIG. 15;

FIG. 17 is a side, partial cross-sectional view of another embodiment ofan anchor including a plurality of spiraling wide flexible wires, theanchor being in an undeployed configuration;

FIG. 18 is a side cross-sectional view of the anchor of FIG. 17 with theanchor in a deployed configuration;

FIG. 19 is a perspective view of another embodiment of an anchorincluding a distal bead and a bellows, the anchor being in an undeployedconfiguration;

FIG. 20 is a perspective view of the anchor of FIG. 19 with the anchorin a deployed configuration;

FIG. 21 is a side view of another embodiment of an anchor including adistal bead and an elongated bellows, the anchor being in an undeployedconfiguration and having its proximal end coupled to a segment of acannula;

FIG. 22 is a side cross-sectional view of one embodiment of a surgicalaccess device including a cannula formed of a flexible bellows andhaving a conical elastic component disposed in the cannula, the surgicalaccess device being positioned in an opening in tissue;

FIG. 23 is a side cross-sectional view of another embodiment of asurgical access device including a cannula formed of a flexible bellowsand having an obturator disposed through the cannula and inserting stayclips within the cannula, the surgical access device being positioned inan opening in tissue;

FIG. 24 is a side cross-sectional view of the surgical access device ofFIG. 23 with the stay clips deployed in the cannula and with theobturator removed from the surgical access device;

FIG. 25 is a side cross-sectional view of one embodiment of a surgicalaccess device positioned within an opening in tissue and having ahousing with a cannula distally extending therefrom, the cannulaincluding a plurality of segments movably coupled to one another andhaving an anchor in a deployed configuration at a distal end thereof,the surgical access device including a plurality of pull stringsconfigured to move the segments relative to one another and to move theanchor between deployed and undeployed configurations;

FIG. 26 is a top view of the surgical access device of FIG. 25;

FIG. 27 is a side cross-sectional view of the cannula of FIG. 25 havinga sleeve disposed therearound and showing a proximal segment beingremovable from the cannula;

FIG. 28 is a side cross-sectional view of another embodiment of asurgical access device positioned within an opening in tissue, having ahousing with a cannula distally extending therefrom, and having asurgical instrument inserted through a working channel of the surgicalaccess device, the cannula including a plurality of segments movablycoupled to one another, having an anchor in a deployed configuration ata distal end thereof, and the cannula having a sleeve formed of aplurality of discrete members disposed therearound;

FIG. 29 is a perspective view of one of the segments of FIG. 28;

FIG. 30 is a side cross-sectional view of another embodiment of acannula including a plurality of segments movably coupled to oneanother, the segments each including a biasing spring;

FIG. 31 is a perspective view of segments of FIG. 30;

FIG. 32 is a side cross-sectional view of one embodiment of a cannulaincluding a plurality of segments movably and removably coupled to oneanother, the segments each including a flexion region;

FIG. 33 is a side cross-sectional view of the cannula of FIG. 32 withthe cannula in a curved position;

FIG. 34 is a side, partial cross-sectional, partially transparent viewof an anchor movably and removably coupled to one of the segments ofFIG. 32, the anchor having a plurality of threads formed thereon;

FIG. 35 is a perspective view of the segment and the anchor of FIG. 35;

FIG. 36 is a side cross-sectional view of the segment and the anchor ofFIG. 35 having an obturator inserted through a proximal end of a workingchannel defined by the segment and the anchor, the obturator having anexpander tool disposed within an inner passageway thereof;

FIG. 37 is a side cross-sectional view of the segment and the anchor ofFIG. 36 with a distal tip of the obturator located distal to the anchorand the expander tool disposed within the anchor;

FIG. 38 is a side cross-sectional view of the segment and the anchor ofFIG. 37 with the expander tool expanding a distal portion of theobturator to form a compression lock between the obturator and theanchor;

FIG. 39 is a side partial cross-sectional view of one embodiment of asurgical access device positioned within an opening in tissue, includinga plurality of movably and removably coupled segments with an anchor ata distal end thereof in an undeployed configuration, and having asurgical instrument inserted through a working channel of the surgicalaccess device, the surgical access device including a plurality of pullstrings configured to move the segments relative to one another and tomove the anchor between deployed and undeployed configurations;

FIG. 40 is a side partial cross-sectional view of the surgical accessdevice of FIG. 39 with a housing removably attached to a proximal-mostone of the segments, the anchor being in a deployed configuration;

FIG. 41 is a side partial cross-sectional view of one embodiment of asurgical access device positioned within an opening in tissue andincluding a rotatable housing having a cannula formed of a plurality ofmovably and removably coupled segments extending distally therefrom, thesurgical access device including a plurality of pull strings configuredto move the segments relative to one another when the housing rotates;

FIG. 42 is a side cross-sectional view of the surgical access device ofFIG. 41;

FIG. 43 is an exploded perspective view of the housing and pull stringsof FIG. 41; and

FIG. 44 is a side partial cross-sectional view of another embodiment ofa surgical access device positioned within an opening in tissue andincluding a rotatable housing having a cannula formed of a plurality ofmovably and removably coupled segments extending distally therefrom, thesurgical access device including a plurality of pull strings configuredto move the segments relative to one another when the housing rotates.

DETAILED DESCRIPTION OF THE INVENTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Various exemplary methods and devices are disclosed for providingsurgical access into a body cavity. In general, the methods and devicesprovide access through tissue to a body cavity underlying the tissueusing a surgical access port configured to be secured within an openingin the tissue to allow access therethrough. In an exemplary embodiment,a surgical access port is provided that has an adjustable longitudinallength. Because tissue thicknesses can vary, having a surgical accessport with an adjustable longitudinal length of the surgical access portcan allow the surgical access port to be appropriate for use with avariety of tissue thicknesses and can facilitate secure positioning ofthe surgical access port within tissue. A surgical access port with anadjustable longitudinal length can minimally extend into a body cavityunderlying the tissue where the surgical access port could harm bodystructures within the body cavity and/or interfere with instrumentsperforming a surgical procedure in the body cavity. The surgical accessport's longitudinal length can be selectively adjusted after it ispositioned within an opening in tissue, thereby allowing thelongitudinal length to be tailored to a particular tissue's thicknesswith a reduced or nonexistent need to guess or pre-measure a tissue'sthickness. In some embodiments, an anchor can be coupled to a distal endof the surgical access port to help secure the surgical access portwithin the tissue opening by engaging a distal side of the tissue, e.g.,tissue facing the body cavity. The anchor can be configured to bedeployed when the surgical access port's longitudinal length isselectively adjusted, which can quicken setup of the surgical accessport. Optionally, the anchor can be removably coupled to the distal endof the surgical access port, thereby allowing any one of a plurality ofanchors to be selectively coupled thereto based on a particular surgicalprocedure, a particular tissue's thickness, a particular body cavity inwhich it will be inserted, etc.

The various surgical access devices can include an elongate tubularmember, cannula, or other member for forming a pathway through tissue(hereinafter generally referred to as a cannula). The cannula can extenddistally from a proximal housing configured to be at least partiallydisposed outside a patient's body, and it can be configured to bepositioned within an opening in a patient's body, such as through skin.The proximal housing can include one or more sealing ports that can eachdefine working channels extending through the housing and aligned withthe cannula. A person skilled in the art will appreciate that thecannula can include one or more sealing ports, in addition or inalternative to one or more sealing ports in the housing. Any and all ofthe surgical access devices described herein can also include variousother features, such as one or more ventilation ports to allowevacuation of smoke during procedures that utilize cautery, and/or oneor more insufflation ports through which the surgeon can insufflate theabdomen to cause pneumoperitenium, as described by way of non-limitingexample in U.S. Patent Publication No. 2006/0247673 entitled “Multi-portLaparoscopic Access Device” filed Nov. 2, 2006, which is herebyincorporated by reference in its entirety. The insufflation port can belocated anywhere on the device, can have any size, and can accept a leurlock or a needle, as will be appreciated by those skilled in the art.

In use, and as also further discussed below, the surgical access devicesdisclosed herein can provide access to a patient's body cavity. At leasta portion of the cannula can be positionable within an opening in apatient's body such that a distal portion of the cannula extends into apatient's body cavity and at least a portion of the housing ispositioned adjacent to the patient's skin on an exterior of thepatient's body. In some embodiments, the device may not include ahousing, in which case at least a proximal portion of the cannula can bepositioned adjacent to the patient's skin on an exterior of thepatient's body when another portion of the cannula is positioned withinan opening in a patient's body. A lumen in the cannula and the housingcan form a pathway through the opening in a patient's body so thatsurgical instruments can be inserted from outside the body to aninterior body cavity. The elasticity of the skin of the patient canassist in the retention of the cannula in the body opening or incisionmade in the body. The cannula can be placed in any opening within apatient's body, whether a natural orifice or an opening made by anincision. In one embodiment, the cannula can be substantially flexibleso that it can easily be maneuvered into and within tissue as needed. Inother embodiments, the cannula can be substantially rigid orsubstantially semi-rigid.

Typically, during surgical procedures in a body cavity, such as theabdomen, insufflation is provided through the surgical access device toexpand the body cavity to facilitate the surgical procedure. Thus, inorder to maintain insufflation within the body cavity, most surgicalaccess devices include at least one seal disposed therein to prevent airand/or gas from escaping when surgical instruments are insertedtherethrough. Various sealing elements are known in the art, buttypically the surgical access device can include at least one instrumentseal that forms a seal around an instrument disposed therethrough, butotherwise does not form a seal when no instrument is disposedtherethrough, at least one channel seal or zero-closure seal that sealsthe working channel created by the sealing port when no instrument isdisposed therethrough, or a combination instrument seal and channel sealthat is effective to both form a seal around an instrument disposedtherethrough and to form a seal in the working channel when noinstrument is disposed therethrough. A person skilled in the art willappreciate that various seals known in the art can be used including,e.g., duckbill seals, cone seals, flapper valves, gel seals, diaphragmseals, lip seals, iris seals, etc. A person skilled in the art will alsoappreciate that any combination of seals can be included in any of theembodiments described herein, whether or not the seal combinations arespecifically discussed in the corresponding description of a particularembodiment.

In an exemplary embodiment illustrated in FIGS. 1 and 2, a surgicalaccess device 10 can include a housing 12 and a cannula 14 distallyextending therefrom. The housing 12 and the cannula 14 can define aworking channel 16 extending through the device 10 and being configuredto slidably and removably receive an obturator 18 and/or any number ofother surgical instruments therein. Generally, the device 10 can beconfigured to be positioned within an opening in tissue to provideaccess to a surgical site and allow a surgical instrument to be insertedthrough the working channel 16 to perform a surgical procedure at thesurgical site. An anchor or anchor segment 20, generally referred to asan “anchor,” can be located at a distal end 14 d of the cannula 14 andcan assist in securing the device 10 within an opening in tissue, asdiscussed further below. The anchor 20 can be configured to self-deploy,or the obturator 18 can be configured to deploy the anchor 20, as alsodiscussed further below. As illustrated, the cannula 14 can include aplurality of beads, modules, or segments 34 a, 34 b, 34 c, generallyreferred to as “segments,” movably coupled together such that thecannula 14 can bend and can adjust in longitudinal length. Generally,the segments 34 a, 34 b, 34 c can allow the cannula 14 to be configuredas an axially-expandable, articulating tubular member configured to besecurely positioned within tissue of any thickness, e.g., in a range ofabout 1-7 cm thick, and articulate therein to improve access to a bodycavity underlying the tissue.

The housing 12, the cannula 14, the obturator 18, and the anchor 20 caneach have a variety of sizes, shapes, and configurations. Generally, thehousing 12 can be configured to provide a pathway for receiving asurgical instrument such the obturator 18, an endoscope, a retractor, adissector, a cutting instrument, etc. Exemplary housing configurationsare described in more detail in U.S. Pat. No. 6,017,356 entitled “MethodFor Using A Trocar For Penetration And Skin Incision”, issued on Jan.25, 2000, U.S. Patent Publication No. 2004/0230161 entitled “Trocar SealAssembly,” filed on Mar. 31, 2004, and U.S. Patent Publication No.2007/0185453 entitled “Conical Trocar Seal,” filed on Oct. 15, 2003,which are hereby incorporated by reference in their entireties.

The housing 12 can include proximal and distal sealing elements 22 a, 22b configured to provide at least one of a channel seal and an instrumentseal. Although the housing 12 in the illustrated embodiment includes twosealing elements 22 a, 22 b, a person skilled in the art will appreciatethat the device 10 can include any number of sealing elements and thatin addition or in alternative to at least one sealing element in thehousing 12, the cannula 14 can include one or more sealing elements.

The sealing elements 22 a, 22 b can have a variety of sizes, shapes, andconfigurations. As shown in the illustrated embodiment, the distalsealing element 22 b can include a duckbill seal that provides a channelseal, and the proximal seal 22 a can include a septum seal that providesan instrument seal. In use, when a surgical instrument is passed throughthe proximal seal 22 a, the proximal seal 22 a can engage and form aseal around an outer surface of the instrument to thereby preventpassage of fluids and gas through the seal 22 a. When no instrument isdisposed therethrough, the proximal seal 22 a will generally not form aseal in the working channel 16. A person skilled in the art willappreciate that while an instrument seal in the form of a septum seal isshown, any seal can be used. Exemplary instrument seal configurationsare described in more detail in U.S. patent application Ser. No.12/399,482 entitled “Methods And Devices For Providing Access Into ABody Cavity,” filed Mar. 6, 2009, U.S. Patent Publication No.2004/0230161 entitled “Trocar Seal Assembly,” filed on Mar. 31, 2004,and U.S. Patent Publication No. 2007/0185453 entitled “Conical TrocarSeal,” filed on Oct. 15, 2003, which are hereby incorporated byreference in their entireties. When the instrument is further insertedthrough the distal seal 22 b, the instrument can open the distal seal 22b and pass into the cannula 14. A person skilled in the art willappreciate that while a channel or zero-closure seal in the form of aduckbill seal is shown for the distal seal 22 b, any seal, e.g.,duckbill seals, cone seals, flapper valves, gel seals, diaphragm seals,lip seals, iris seals, non-linear sealing elements such as sealingelements with an S-shaped opening, etc., can be used. Generally, azero-closure seal can be configured to form a seal in a working channelwhen no instrument is disposed therethrough to thus prevent the leakageof insufflation gases delivered through the surgical access device tothe body cavity. A duckbill seal can generally have opposed flaps thatextend at an angle toward one another in a distal direction and thatcome together at a distal end to form a seal face. The opposed flaps canbe movable relative to one another to allow the seal face to movebetween a closed position, in which no instrument is disposedtherethrough and the seal face seals the working channel of the surgicalaccess device, and an open position in which an instrument is disposedtherethrough. A duckbill seal can include various other features, asdescribed in more detail in U.S. Patent Publication No. 2009/0005799,entitled “Duckbill Seal with Fluid Drainage Feature,” filed on Jun. 29,2007, which is hereby incorporated by reference in its entirety. Inaddition, the seal face of the duckbill seal can be in any nonlinearshape or configuration known in the art, for example in an S-shapedconfiguration, as described in more detail in U.S. Pat. No. 5,330,437,entitled “Self Sealing Flexible Elastomeric Valve and Trocar Assemblyfor Incorporating Same,” filed Nov. 12, 1993, which is herebyincorporated by reference in its entirety.

The housing 12 can include an insufflation port 24 extending from asidewall of the housing 12, although a person skilled in the art willappreciate that the insufflation port 24 can be located elsewhere in thehousing 12 or in other locations. A person skilled in the art will alsoappreciate that the device 10 can include any number of insufflationports and that an insufflation port can have a variety ofconfigurations. Generally, the insufflation port 24 can be configured topass an insufflation fluid through a flexible insufflation tube and intoan insufflation orifice of the insufflation port 24 where the fluid canflow through the working channel 16 and into a body cavity. A stopcockcan control fluid flow through the insufflation tube. In an exemplaryembodiment, a surgical access device kit can include multiple modularstopcocks, e.g., an insufflation/vent three-way version, a twist toactivate version, a spring loaded version, etc.

The housing 12 can fixedly or removably attach to the cannula 14 in avariety of ways. In the illustrated embodiment, a distal end 12 d thehousing 12 and a proximal end Hp of the cannula 14 include complementarymating features configured to movably and removably mate the housing 12and the cannula 14 together. Although the mating features can have avariety of configurations, e.g., welded elements, snap-fit elements,threads, etc., in the illustrated embodiment the housing's distal end 12d includes a female member 32, e.g., an opening, socket, or cavity,configured to receive a male member, e.g., a protrusion, ball, or knob,at the cannula's proximal end 14 p configured to be movably disposed inthe female member 32. In this way, the cannula 14 can move relative tothe housing 12, e.g., with the male member being rotatable within thefemale member 32, which can facilitate positioning of the cannula 14within a tissue opening. The housing's female member 32 can have avariety of sizes, shapes, and configurations, such as shown in FIG. 2with the female member 32 including a distal tapered portion 32 dtapering outwardly in a distal direction to provide adequate space forthe cannula 14 to move, as discussed further below, and a proximal pivotsocket portion 32 p configured to receive the cannula's male membertherein by interference or snap fit. The proximal pivot socket portion32 p can have a rounded shape complementary to a rounded shape of thecannula's male member to allow the male member to freely rotate thereinto allow polyaxial movement of the cannula 14 relative to the housing12.

The cannula's male member can have a variety of sizes, shapes, andconfigurations, as can the cannula 14. Generally, the cannula 14 can beformed from a plurality of segments 34 a, 34 b, 34 c movably coupledtogether with proximal ends of each of the segments 34 a, 34 b, 34 cincluding a male member 36 a, 36 b, 36 c configured to be received in adistal female member 38 a, 38 b, 38 c of another segment 34 a, 34 b, 34c or in the distal female member 32 of the housing 12. Although thecannula 14 is illustrated with three segments 34 a, 34 b, 34 c, thecannula 14 can include any number of segments. As shown in FIG. 2, themale member 36 a of the proximal-most one of the segments 34 a,illustrated as a standalone element in FIG. 3, can be configured to beseated in the housing's female member 32 by interference or snap fit tomate the cannula 14 to the housing 12.

The complementary mating features of the housing 12 and the cannula 14can also be configured to allow the housing 12 to be removable from thecannula 14, e.g., through unthreading, by unsnapping the proximal-mostsegment's male member 36 a from the housing's female member 32, etc.,thereby allowing housings and cannulas of various sizes and includingvarious features to be mixed and matched as appropriate for a particularsurgical application. Similarly, the complementary mating features ofthe cannula's segments 34 a, 34 b, 34 c can be configured to allow anynumber of segments to be added to or removed from the cannula 14,thereby allowing the cannula's longitudinal length 14L to be adjusted asdesired for a particular surgical application. In other words, thesegments 34 a, 34 b, 34 c can be modular. Optionally, a plurality ofsegments, anchors, and/or housings can be provided as part of a kit thatcan be assembled and/or disassembled to form a surgical access devicetailored for a particular surgical application.

The segments 34 a, 34 b, 34 c can have a variety of sizes, shapes, andconfigurations, and can be same or different from any of the othersegments 34 a, 34 b, 34 c. In the illustrated embodiment, each of thesegments 34 a, 34 b, 34 c is identical. The segments 34 a, 34 b, 34 ccan be composed of any one or more flexible and/or rigid materials,although the segments 34 a, 34 b, 34 c in the illustrated embodiment areflexible and are formed of at least one flexible, puncture-resistantpolymer, e.g., isoprene, polyethylene, and polypropylene. Optionally,the proximal-most segment 34 a and/or the distal-most segment 34 c canbe formed of a material more rigid than a material forming one or moresegments 34 b connected therebetween, which can help facilitateinsertion of the cannula 14 through a tissue opening and retention ofthe cannula 14 therein.

Generally, referring to the proximal-most segment 34 a illustrated inFIG. 3, the segment 34 a can include a bottle-shaped body with abulbous, spherical, distal portion including the female member 38 atherein, a proximal head portion including the male member 36 a, and asmaller-diameter, cylindrical, proximal neck portion extending betweenthe proximal and distal portions and configured to axially move into andout of an adjacent segment's female member. In this way, when multiplesegments are attached together, the cannula 14 can have a scallop-shapedexternal surface, as illustrated in FIGS. 1 and 2. In other exemplaryembodiments, segments forming a cannula can each have a cube-shaped,rectangular-shaped, or cylindrically-shaped distal portion such that thecannula can have a substantially constant outer diameter at least whenthe cannula is in a compressed configuration.

An external surface of the segment 34 a, e.g., on the body, canoptionally include at least one gripping feature (not shown) formedthereon, e.g., a textured surface, at least one spiraling thread, etc.,that can be configured to facilitate the segment's retention withintissue. A bore or lumen 44 can extend between proximal and distal ends34 p, 34 d of the segment 34 a. A distal portion of the bore 44 candefine the segment's female member 38 a, and a proximal portion of thebore 44, e.g., within the male member 34 a, can taper radially outwardto facilitate insertion of a surgical instrument therethrough.Collectively, the bores 44 of the segments 34 a, 34 b, 34 c can axiallyalign with one another along a longitudinal axis A of the device 10 toform a portion of the device's working channel 16.

The segments' female members 38 a, 38 b, 38 c can have a variety ofsizes, shapes, and configurations, such as shown in FIGS. 2 and 3 withthe female members 38 a, 38 b, 38 c each including a distal taperedportion 38 d tapering outwardly in a distal direction to facilitatebending and axial expansion of the cannula 14, and a proximal pivotsocket portion 38 p configured to receive the another segment's malemember or a male member 40 of the anchor segment 20. In this way, thecannula 14 can include the segments 34 a, 34 b, 34 c movably linkedtogether with the anchor segment 20 movably linked to the distal-mostone of the segments 34 c. Similar to the housing's proximal pivot socketportion 32 p, the segments' female members 38 a, 38 b, 38 c can eachhave a rounded shape complementary to rounded shapes of the segments'male members 36 a, 36 b, 36 c such that each male member can rotatewithin its respective female member, thereby allowing free movement ofeach of the segments 34 a, 34 b, 34 c and the anchor segment 20 relativeto a remainder of the cannula 14 and to the housing 12. The femalemembers 32, 38 a, 38 b, 38 c can be expandable to facilitate removal andinsertion of a male member.

FIG. 4 illustrates another exemplary embodiment of a segment 34″ inwhich the segment's female member 38″ has a square or rectangularproximal pivot socket portion 38 p″, which can help facilitatelongitudinal movement of another segment's male member, which can have aproximal square or rectangular portion similar to the segment's malemember 36″.

Referring again to FIGS. 1-3, as mentioned above, the segments 34 a, 34b, 34 c can be movably coupled together such that the segments 34 a, 34b, 34 c can polyaxially move relative to one another. The segments 34 a,34 b, 34 c can also be longitudinally movable relative to one anotheralong the device's and working channel's longitudinal axis A such thatthe longitudinal length 10L of the device 10 can be adjusted, and moreparticularly such that a longitudinal length 14L of the cannula 14 canbe adjusted. The cannula 14 can be configured to move between acompressed configuration in which the cannula 14 has a minimumlongitudinal length 14L and an expanded configuration, shown in FIGS. 1and 2, in which the cannula 14 has a longitudinal length 14L greaterthan its minimum longitudinal length 14L. The cannula 14 can be biasedto the compressed configuration such that when positioned within atissue opening, the cannula 14 can move to a longitudinal lengthapproximating a longitudinal length of the tissue opening. In this way,the device 10 can be securely positioned within tissues of varyingthicknesses while reducing chances of damaging or interfering with anymatter within a body cavity to which the device 10 provides access.

To facilitate longitudinal length adjustment of the cannula 14, each ofthe segments 34 a, 34 b, 34 c can include one or more flexible biasingelements 42 a, 42 b, 42 c. In the illustrated embodiment, shown in FIGS.2 and 3, each of the segments 34 a, 34 b, 34 c includes two biasingelements 42 a, 42 b, 42 c, a proximal radially-extending deflectableflange having a first diameter and a distal radially-extendingdeflectable flange having a second, larger diameter, but the segments 34a, 34 b, 34 c can include any number of biasing elements. The biasingelements 42 a, 42 b, 42 c can extend circumferentially or around aperimeter of their respective segments 34 a, 34 b, 34 c such that whenthe biasing element of one segment is inserted into the bore of anadjacent segment, that biasing element engages a perimeter of the boreof the adjacent segment so as to form a fluid-tight seal between thosetwo segments. In this way, a fluid-tight seal can be formed between eachof the segments 34 a, 34 b, 34 c, between the housing 12 and theproximal-most segment 34 a, and between the distal-most segment 34 c andthe anchor 20 such that the working channel 16 can be fluid-tight toprevent escape of insufflation fluid and to prevent entry or exit ofother unwanted material into or out of the cannula 14.

One or more of the segments 34 a, 34 b, 34 c can optionally include achannel seal, e.g., a lip seal, which can also help prevent escape ofinsufflation fluid and to prevent entry or exit of other unwantedmaterial into or out of the cannula 14. The channel seal can be locatedanywhere within the segment's inner lumen, such as at a proximal endthereof, e.g., within the male member of the segment. Optionally, aprotective sleeve, discussed further below, can be disposed over anexternal surface of the cannula 14 to further facilitate sealing of thecannula 14 as well as reduce tissue trauma and facilitate insertion andremoval of the cannula 14 from tissue.

The biasing elements 42 a, 42 b, 42 c can also be configured to becompressible to allow bending of the cannula 14. As shown in anotherexemplary embodiment in FIG. 5 showing a portion of a cannula 14′including five movably coupled segments 34′ each having two flanges orbiasing elements 42′, the biasing elements 42′ can be configured tocompress in a direction of cannula bending, e.g., to the right asillustrated in FIG. 5, while maintaining a fluid-tight seal, e.g.,maintaining contact within segment bores in which they are respectivelydisposed.

Referring again to FIGS. 1-3, the biasing elements 42 a, 42 b, 42 c canbe configured to be contained within an adjacent female member and tobias their respectively associated male and female members intoengagement with one another, e.g., the biasing elements 42 a of theproximal-most segment 34 a biasing the proximal-most segment's malemember 36 a into engagement with the housing's female member 32, thebiasing elements 42 c of the distal-most segment 32 c biasing thesegment's male member 36 c into engagement with the middle segment'sfemale member 38 b, etc. In other words, the biasing elements 42 a, 42b, 42 c can be configured to bias the cannula 14 to the compressed ordefault configuration. With the cannula 14 in the compressedconfiguration, the biasing elements 42 a, 42 b, 42 c can each be in adefault configuration, as illustrated in FIG. 3 showing the biasingelements 42 a of the proximal-most segment 34 a in the defaultconfiguration. In the default configuration, the biasing elements 42 a,42 b, 42 c can extend radially and substantially perpendicularly outwardfrom their respective segment bodies. The biasing elements 42 a, 42 b,42 c can be configured to move from the default configuration to allowdistal movement of their respective segments 34 a, 34 b, 34 c such thatthe longitudinal length 14L of the cannula 14, and hence thelongitudinal length 10L of the device 10, increases. In other words, thebiasing elements 42, 42 b, 42 c can be configured as springs thatcompress and expand to allow axial compression and expansion of thecannula 14. FIG. 2 illustrates the cannula 14 in the expandedconfiguration with each of the biasing elements 42 a, 42 b, 42 c bentand with each of the segments 34 a, 34 b, 34 c moved in a distaldirection. Although FIG. 2 illustrates each of the segments 34 a, 34 b,34 c moved and each of the biasing elements 42 a, 42 b, 42 c bent, anyone or more of the biasing elements 42 a, 42 b, 42 c can bend to allowany one or more of the segments 34 a, 34 b, 34 c to move to adjust thecannula's longitudinal length 14L.

The cannula 14 can be configured to be held or locked in the expandedconfiguration when positioned in a tissue opening and to dynamicallymove toward the compressed configuration, and possibly all the way tothe compressed configuration, to reduce its longitudinal length 14Lafter being inserted into the tissue opening. In this way, when thedevice 10 is positioned with an opening in tissue, the cannula 14 can bein the expanded configuration and then move into the compressedconfiguration to adjust the cannula 14 to the tissue's thickness. In anexemplary embodiment, the obturator 18 can be configured to hold thecannula 14 in the expanded configuration and to be at least partiallyremoved from the working channel 16 to allow the cannula 14 to movetoward the compressed configuration. However, as mentioned above, anyinstrument can be disposable through the working channel 16 defined bythe housing 12 and the cannula 14, and any instrument can be configuredto facilitate adjustment of the cannula's longitudinal length 14L.

The obturator 18 can have a variety of sizes, shapes, andconfigurations. Exemplary embodiments of an obturator are described inmore detail in U.S. Pat. No. 6,017,356 entitled “Method For Using ATrocar For Penetration And Skin Incision,” issued on Jan. 25, 2000, andU.S. Patent Publication No. 2007/0260273 entitled “EndoscopicTranslumenal Surgical Systems,” filed May 8, 2006, which are herebyincorporated by reference in their entireties.

Generally, the obturator 18 can include an elongate shaft 26 having aproximal end 26 p including a handle 28 configured to be handheldoutside a patient's body and a distal end 26 d with a tip 30 configuredto be inserted through tissue. The obturator 18 in the illustratedembodiment is a solid member and with at least the shaft 26 beingsubstantially flexible, but the obturator 18 can be substantially rigidand/or hollow. The shaft 26 can be made substantially flexible usingvarious techniques. For non-limiting example, the shaft 26 can be formedfrom a flexible material, and/or it can include one or more featuresformed therein to facilitate flexibility, such as a plurality ofcut-outs or slots. In other embodiments, the shaft 26 can be formed froma plurality of linkages that are movably coupled to one another. Theshaft 26 can also include regions that vary in flexibility. Fornon-limiting example, certain portions of the shaft 26, such as thedistal portion, can be more rigid than other portions of the shaft 26,such as the proximal portion, to facilitate insertion of the obturator18 through tissue alone or disposed within the cannula 14. Varyingflexibility of the shaft 26 can be achieved in a variety of ways as willbe appreciated by a person skilled in the art, such as by forming theshaft 26 from different materials, varying the diameter or thickness ofthe shaft 26, etc. The shaft 26 can also include other features tofacilitate use, such as one or more spiral wires embedded therein andconfigured to preventing kinking of the shaft 26.

The size and shape of the shaft 26 can vary, but as shown in FIG. 1, theshaft 26 can have a longitudinal length 26L greater than a longitudinallength 10L of the device 10 such that the obturator 18 can be insertedthrough the device's working channel 16 with the shaft's proximal end 26p located proximal to the housing 12 and the shaft's distal end 26 dlocated distal to the anchor 20. The obturator's handle 28 can have amaximum diameter greater than a diameter of at least a proximal-most endof the working channel 16, thereby preventing the obturator 18 frombeing fully inserted into the device 10 through a proximal end 10 pthereof.

The obturator's distal tip 30 can also have a variety of shapes, sizes,and configurations. Generally, the tip 30 can be configured to penetratetissue. The tip 30 can be composed of any one or more flexible and/orrigid materials, although the tip 30 in the illustrated embodiment isrigid, e.g., composed of stainless steel, titanium, etc., to help thetip 30 penetrate tissue. In an exemplary embodiment, the tip 30 can betransparent to allow visualization therethrough. For non-limitingexample, an endoscope (not shown) can be proximally inserted into ahollow obturator and be disposed within the hollow obturator and providevisualization through the obturator's clear distal tip. The tip 30 canbe integrally formed with a reminder of the shaft 26, or it and/or thetip 30 can be removably or fixedly attached to the shaft 26, e.g.,through an interference fit, an adhesive, ultrasonic welding, etc. Thetip 30 can have a variety of shapes, e.g., conical (as shown in FIG. 1),triangular, rectangular, rounded, etc. The tip 30 can include one ormore features to help it to penetrate tissue, e.g., a tapered shape, abeveled edge (including a chamfered edge), a pointed needle, anelectronic cutter, a sharp cutting blade, etc. Various exemplaryconfigurations for the tip 30 are described in more detail in previouslymentioned U.S. Patent Application No. 2007/0260273 entitled “EndoscopicTranslumenal Surgical Systems,” filed May 8, 2006.

The distal end 26 d of the obturator 18 can also be configured to engagethe anchor 20 to help move the cannula 14 between the expanded andcompressed configurations and to facilitate deployment of the anchor 20.In other words, the obturator 18 and the anchor 20 can be configured tobe keyed together. As illustrated in FIGS. 1, 2, and 6, the obturator 18and the device 10 can include an engagement and release mechanism to keyto each other. The engagement and release mechanism can include abayonet latch mechanism. At least one bayonet foot or pin, e.g., aplurality of radially arranged bayonet feet or pins 48 spacedequidistantly or any other distance apart, can extend any length from anouter perimeter of the obturator 18, e.g., from an outer sidewall of theobturator 18, and the pins 48 can be configured to engage correspondingslots 50 formed in an inner circumferential surface of the anchor 20.The slots 50 can have any shape and size and can be the same as ordifferent from any other of the slots 50. As discussed further below,the slots 50 can each include a vertically-extending portion in whichthe pins 48 can be proximally inserted and a laterally-extending portionin which the pins 50 can laterally slide. The pins 48 can have any shapeand size and can be the same as or different from any other of the pins48. The pins 48 can be configured to be lowered into thevertically-extending portion of the slots 50 in the anchor 20 and ifidentical, as in the illustrated embodiment, can be interchangeablylowered into any of the slots 50. Exemplary embodiments of bayonet latchmechanisms and other engagement and release features are described inmore detail in U.S. patent application Ser. No. 12/399,482 entitled“Methods and Devices for Providing Access to a Body Cavity” filed onMar. 6, 2009, and U.S. patent application Ser. No. 12/512,542 entitled“Methods and Devices for Providing Access Into a Body Cavity” filed onJul. 30, 2009, which are hereby incorporated by reference in theirentireties.

With the obturator 18 disposed in the working channel 16 and the bayonetpins 48 engaging their corresponding anchor slots 50, the obturator 18can be moved distally relative to the device 10 to distally move theanchor 20 relative to at least the device's housing 12, therebyincreasing the device's longitudinal length 10L by increasing thecannula's longitudinal length 14L. In other words, distal movement ofthe obturator 18 relative to the device 10 can flex one or more of thebiasing elements 42 a, 42 b, 42 c, 46 to move one or more of thesegments 34 a, 34 b, 34 c and/or the anchor 20 along the device'slongitudinal axis A to change the device's longitudinal length 10L. Thecannula 14 can alternatively or additionally be moved by hand betweenthe expanded and compressed configurations. For clarity, the obturator18, a hand, and/or other member holding the cannula 14 in the expandedconfiguration is not shown in FIG. 2.

The obturator 18 can also be configured to rotate about a longitudinalaxis A2 of the obturator 18, which is the same as the longitudinal axisA of the working channel 16, when the obturator 18 is disposed therein,to deploy the anchor 20, as discussed further below.

The anchor 20, also illustrated in FIGS. 6-10, can be configured to becoupled to the distal-most one of the segments 34 c and can have avariety of sizes, shapes, and configurations. Although the anchor 20 canbe fixedly or removably attached to the cannula 14, in the illustratedembodiment, the anchor 20 is removably mated to the distal-most one ofthe segments 34 c by interference or snap fit. As mentioned above, theproximal male member 40 of the anchor segment 20 can be received withinthe distal-most one of the segments' female member 38 c to movablycouple the anchor segment 20 thereto such that the anchor segment 20 canpolyaxially and longitudinally move relative thereto similar to movementdiscussed above regarding the segments 34 a, 34 b, 34 c. The anchor 20can also include one or more biasing elements 46 configured and usedsimilarly to the biasing elements 42 a, 42 b, 42 c of the segments 34 a,34 b, 34 c, although the anchor's biasing elements 46 need not beidentical to the segments' biasing elements 42 a, 42 b, 42 c.

The anchor 20 can be configured to change shapes to facilitatesecurement of the device 10 within tissue. As in the illustratedembodiment, the anchor 20 can be configured to move between a firstconfiguration, shown in FIGS. 1, 2, and 6, in which the anchor 20 has afirst outer diameter D1, and a second configuration, shown in FIGS. 8and 9, in which the anchor 20 has a second, larger outer diameter D2.The first outer diameter D1 can be equal to or less than a maximum outerdiameter D3 of the cannula 14, while the second outer diameter D2 can begreater than the cannula's maximum outer diameter D3. Because a tissueopening in which the device 10 is positioned generally has a diametersubstantially equal to the cannula's maximum outer diameter D3, thelarger second outer diameter D2 can help prevent the anchor 20 fromproximally advancing into the tissue opening.

The anchor 20 can include a proximal rim 56 and a distal rim 58 havingan expandable mid-portion extending therebetween. The expandablemid-portion can have a variety of configurations, such as shown in theillustrated embodiment with a plurality of extending flexible cables,strings, threads, bands, ribbons, strips, or wires 52, generallyreferred to as “wires,” spaced longitudinally apart from one another andextending between the rims 56, 58 with terminal ends of each of thewires 52 attached to the proximal and distal rims 56, 58, as shown inFIGS. 2 and 7. The proximal and distal rims 56, 58 can each include arigid ring-shaped member as in the illustrated embodiment, but they caneach have a variety of sizes, shapes, and configurations. The wires 52can each extend substantially parallel to the longitudinal axis A of theworking channel 16 when the anchor 20 is in the first configuration, asshown in FIGS. 1, 2, and 7. The wires 52 can be radially arranged andspaced equidistantly or any other distance apart from one another, andcan be configured to collapse when the anchor 20 moves from the firstconfiguration to the second configuration. Optionally, a flexible outersheath 54 can be disposed around the wires 52 to help protect the wires52 and prevent the wires 52 from snagging on tissue or other matter. Thesheath 54 can optionally include a gripping feature (not shown), e.g., atextured surface, a non-slip coating, etc., configured to help griptissue and reduce slippage of the anchor 20 against the tissue when theanchor 20 is deployed and abuts the tissue.

One or more longitudinal posts or clips 60, generally referred to as“clips,” can extend proximally from the distal rim 58 and can beconfigured to engage a circumferential channel or groove 62, generallyreferred to as a “groove,” formed in the proximal rim 56, as discussedfurther below. The anchor 20 includes three clips 60, but it can includeany number of clips. The clips 60 and the groove 62 can have any size,shape, and configuration. As in the illustrated embodiment, the clips 60can each include a longitudinally extending bar having a radiallyextending proximal protrusion 60 p configured to engage the groove 62and lock the clip 60 therein.

In use, the anchor 20 can be in the first configuration having thesmaller diameter D1 when the device 10 is inserted through tissue, andthe anchor 20 can be moved to the second configuration having the largerdiameter D2 after the anchor 20 is located in a body cavity underlyingthe tissue. In this way, the anchor 20 can expand to engage a distalsurface of the tissue facing the body cavity to help compress tissuebetween the anchor 20 and the housing 12, with the cannula 14 extendingthrough the tissue opening therebetween. Because the deployed anchor 20with the second outer diameter D2 can be larger than the cannula'smaximum outer diameter D3, the anchor 20 can be prevented from beingdrawn proximally into the tissue opening having substantially the samediameter as the cannula's maximum outer diameter D2.

The anchor 20 can be moved between the first and second configurationsin a variety of ways. In one exemplary embodiment, the anchor caninclude a shape memory material and be configured to automaticallydeploy. Exemplary embodiments of anchors including a shape memorymaterial and being configured to automatically deploy are described inmore detail in U.S. patent application Ser. No. 12/636,205 entitled“Methods And Devices For Providing Access Through Tissue To A SurgicalSite,” filed Dec. 11, 2009, and in U.S. patent application Ser. No.12/636,232 entitled “Methods And Devices For Providing Access ThroughTissue To A Surgical Site,” filed Dec. 11, 2009, which are herebyincorporated by reference in their entireties.

As mentioned above, in the illustrated embodiment, the obturator 18 canbe configured to move the anchor 20 between the first and secondconfigurations. The obturator 18, with the anchor 20 keyed theretothrough engagement of the bayonet pins 48 and the slots 50, can berotated in a first direction, e.g., a clockwise direction, relative tothe anchor 20, thereby causing the bayonet pins 48 to travel laterallywithin the slots 50, e.g., within the laterally-extending portion of theslots 50 away from the vertically-extending portion of the slots 50, toa position in which the pins 48 abut terminal ends of the slots 50,thereby locking the obturator 18 to the anchor 20. One or more of theslots 50 can angle proximally or distally (not shown) at theirrespective terminal ends such that the bayonet pins 48 can proximally ordistally slide and snap into the terminal ends to help ensure that thebayonet pins 48 fully slide through the slots 50 to lock the obturator18 to the anchor 20. In the illustrated embodiment, the bayonet pins 48can move either clockwise or counterclockwise to lock the obturator 18to the anchor 20 because the laterally-extending portions of the slots50 extend in both directions from the vertically-extending portions ofthe slots 50. In some embodiments, the laterally-extending portions ofthe slots 50 can extend in only one direction from thevertically-extending portions of the slots 50.

With the obturator 18 locked to the anchor 20, e.g., with the bayonetpins 48 misaligned from the vertically-extending portion of the slots50, the obturator 18 can be pulled proximally relative to the device 10,as shown in FIG. 8, thereby pulling the distal rim 58 of the anchor 20toward the proximal rim 56 and expanding the wires 52 radially outwardto change the anchor's shape. The obturator 18 can be optionally rotatedabout the working channel's axis A when the obturator 18 is pulledproximally, which can help flare the anchor 20. Pulling the obturator 18in a proximal direction also proximally moves the clips 60 attached tothe anchor's distal rim 58. The clips' protrusions 60 p can have aslanted, tapered, or beveled surface 60 s such that a surface of theproximal rim 56 can urge the clips' protrusions 60 p radially inwardsuntil the protrusions 60 p reach the groove 62 formed in the proximalrim 56. The protrusions 60 p can then move radially outward and snapinto the groove 62, thereby locking the anchor 20 in the secondconfiguration with the anchor 20 deployed, as illustrated in FIGS. 8 and9. The obturator 18 can be removed from the device 10 by rotating theobturator 18 about the obturator's longitudinal axis A2 and the workingchannel's longitudinal axis A to laterally move the bayonet pins 48within the slots 50 until the bayonet pins 48 axially align with thevertically-extending portion of the slots 50, at which point theobturator 18 can be pulled proximally to disengage the bayonet pins 48from the slots 50 and allow removal of the obturator 18 from the device10.

The anchor 20 can also be configured to move from the secondconfiguration with the anchor 20 in a deployed position to the firstconfiguration with the anchor 20 in an undeployed position. In anexemplary embodiment, illustrated in FIG. 10, a release tool 64 can beconfigured to be inserted into the device's working channel 16 and movethe anchor 20 from the second configuration to the first configuration.The release tool 64 is shown as having an elongate shaft with a wedge ata distal end thereof, but the release tool 64 can have a variety ofsizes, shapes, and configurations. In use, the release tool 64 can bemoved in a distal direction until a distal end of the release tool 64engages the anchor's pins 60. The release tool's distal end can be inthe form of a wedge, e.g., a cylindrical member having a slanted,tapered, or beveled edge 66, configured to slidably engage the slanted,tapered, or beveled surface 60 s of the clips 60 and move the clips'protrusions 60 p radially inward and distally such that the clips 60 candisengage from the groove 62. thereby allowing the anchor 20 to move tothe first configuration.

FIGS. 11-13 illustrate another exemplary embodiment of an anchor 20′including a plurality of flexible wires 52′ extending between proximaland distal rims 56′, 58′ of the anchor 20′. A flexible outer sheath 54′,not shown in FIG. 11 for clarity, can be disposed around the wires 52′.The anchor 20′ can generally be configured and used similar to theanchor 20 of FIGS. 1, 2, and 7-10. However, in this illustratedembodiment, instead of extending substantially parallel to alongitudinal axis A′ of the anchor 20′ when the anchor 20′ isundeployed, e.g., in a first configuration shown in FIG. 11, the wires52′ can spiral between the proximal and distal rims 56′, 58′. Whendeployed, e.g., in a second configuration shown in FIGS. 12 and 13, thespiraled wires 52′ can allow a greater surface area of the wires 52′ toabut and grip tissue, with the sheath 54′ optionally positionedtherebetween, than with longitudinal wires.

The wires 52, 52′ discussed above include thin, rod-like members, but inanother exemplary embodiment, an anchor can include a plurality offlexible wide, planar wires. Such wide, planar wires can be configuredand used similar to the wires 52, 52′ discussed above but can allow agreater surface area of the wires to abut tissue, with a sheathoptionally positioned therebetween, than with thin, rod-like members.FIGS. 14-16 illustrate one exemplary embodiment of an anchor 20″including a plurality of flexible wide, planar wires 52″ extendingsubstantially parallel to a longitudinal axis A″ of the anchor 20″between proximal and distal rims 56″, 58″ of the anchor 20″. When theanchor 20″ is deployed, the wires 52″ can bend as shown in FIGS. 15 and16 to increase a diameter of the anchor 20″, with a plurality of posts60″ extending from the distal rim 58″ engaging a groove 62″ formed inthe proximal rim 56″ to at least temporarily lock the anchor 20″ in thedeployed position. FIGS. 17 and 18 illustrate another exemplaryembodiment of an anchor 20″' including a plurality of flexible wide,planar wires 52′″ that spiral between proximal and distal rims 56′″,58′″ of the anchor 52′″.

The anchors 20, 20′, 20″ can each freely collapse when moving from thefirst configuration to the second configuration. In other exemplaryembodiments, an anchor can be configured to bend in at least onepredefined bending region when moving from the first configuration tothe second configuration. Having a predefined bending region can helpmaximize a surface area of the anchor that contacts tissue when theanchor is deployed. FIGS. 19 and 20 illustrate one exemplary embodimentof an accordion-type anchor 820 having a predefined bending region 820 blocated between two adjacent accordion waves 820 w of the anchor 820.When the anchor 820 moves from a first, undeployed configuration, shownin FIG. 19, to a second, deployed configuration, shown in FIG. 20, theanchor 820 can be configured to bend at the predefined bending region820 b. The predefined bending region 820 b can have a variety ofconfigurations, such as being a scored or otherwise weakened portion ofthe anchor 820. In the illustrated embodiment, a ring 821 can bepositioned between the accordion waves 820 w around an exterior surfaceof the anchor 820, within the anchor 820, and/or inside an interiorsurface of the anchor 820. The ring 821 can have a c-shape as shown orcan have another shape, e.g., an o-shape. The ring 821 can be made fromany one or more materials, such as a shape memory material, e.g.,Nitinol, spring steel, etc. The ring 821 can be configured to facilitatedeployment of the anchor 820 and engagement of the anchor 820 withtissue by increasing a force of the anchor's collapse, e.g., by beingbiased to an enlarged ring shape, and by urging the anchor 820 to apredefined diameter in the second configuration that is larger than theanchor's diameter in the first configuration. The anchor 820 canoptionally include a distal retention bead 823 as its distal rim at adistal-most end of the anchor 820. The retention bead 823 can have avariety of sizes, shapes, and configurations, e.g., a sphere.

FIG. 21 illustrates another embodiment of an accordion-type anchor 920having multiple accordion waves 920 w each having a predefined bendingregion 920 b in a mid-portion thereof A c-ring 921 can be positioned atthe predefined bending regions 920 b and/or between the accordion waves920 w around an exterior surface of the anchor 920, within the anchor920, and/or inside an interior surface of the anchor 920. The anchor 920in FIG. 21 is illustrated with a distal retention bead 923 and ascoupled at its proximal end to a spherical segment 934.

As mentioned above, a surgical access device can include a cannulahaving a plurality of biased segments such that the cannula can beconfigured to dynamically adjust its longitudinal length. In someexemplary embodiments, a surgical access device can include a cannulaconfigured to have an adjustable longitudinal length, but the cannulacan be formed of a continuous elongate tubular member rather than aplurality of independent segments coupled together to form a tubularmember. In one exemplary embodiment, a housing can be configured torotate relative to a cannula distally extending therefrom and cut aproximal end of the cannula to adjust the cannula's longitudinal length.Exemplary embodiments of rotatable housings configured to trim a cannulaattached thereto are described in more detail in U.S. patent applicationSer. No. 12/636,205 entitled “Methods And Devices For Providing AccessThrough Tissue To A Surgical Site,” filed Dec. 11, 2009, and in U.S.patent application Ser. No. 12/636,232 entitled “Methods And Devices ForProviding Access Through Tissue To A Surgical Site,” filed Dec. 11,2009, which are hereby incorporated by reference in their entireties.

In another exemplary embodiment, illustrated in FIG. 22, including acontinuous elongate tubular cannula, a surgical access device 1000 caninclude a housing 1012 having a cannula 1014 in the form of a bellowsextending distally therefrom. The cannula 1014 can optionally include aconical elastic component 1015 and/or a molded-in helical coil (notshown) configured to facilitate expansion and collapse of the cannula1014 such that the cannula 1014 can change in longitudinal length and besecurely positioned within a tissue opening 1017. FIGS. 23 and 24illustrate another exemplary embodiment of a surgical access device 1100including a housing 1112 having a cannula 1114 in the form of a bellowsextending distally therefrom. An obturator 1118 can be configured todeploy at least one stay clip 1119, e.g., two spring stock clips, withinthe cannula 1114, as shown in FIG. 23. The stay clips 1119 can beconfigured to remain inside the cannula 1114 when the obturator 1118 isremoved therefrom, as shown in FIG. 24, to exert a radially-outwardforce to aid retention of the cannula 1114 within a tissue opening 1117.

In some exemplary embodiments, a surgical access device can beconfigured to have a selectively adjustable longitudinal length using amanipulable adjustment mechanism. Such a surgical access device caninclude a plurality of segments, or the device's cannula can beotherwise configured to be flexible as a continuous elongate tubularmember.

FIGS. 25 and 26 illustrate an exemplary embodiment of a surgical accessdevice 100 that can generally be configured and used similar to thesurgical access devices described above but that can have itslongitudinal length selectively adjusted using a manipulable adjustmentmechanism in the form of a plurality of pull cables, pull strings, pullthreads, pull bands, pull ribbons, pull strips, or pull wires 174,generally referred to as “pull strings,” spaced longitudinally apartfrom one another and extending along a longitudinal length of the device100. The device 100 can also include a distal platform or seal 182, ascan any of the devices described herein, configured to abut a proximalsurface 172 p of tissue 172 in which the device 100 is positioned tohelp provide a seal and facilitate nonslidable gripping the tissue 172.As illustrated, the device 100 can include a housing 112 and a cannula114 distally extending therefrom. The cannula 114 can include aplurality of segments 134 and an anchor 120 at a distal end thereof, andcan optionally have a protective sleeve disposed therearound.

Although the device 100 is illustrated as having four pull strings 174,a surgical access device can include one or more pull strings, which canhave a variety of sizes, shapes, and configurations. Each of the pullstrings 174 can have a first, distal terminal end 134 d connected to theanchor 120 and a second, proximal terminal end 134 p extendingproximally beyond the housing 112 such that the second terminal end 134p can be manipulated outside tissue 172. A longitudinal length of eachpull string 174 extending between the terminal ends 174 d, 174 p canpass through lumens 176 within necks of the segments 134 to securedlycouple the string 174 thereto. Although the anchor 120 can be removablefrom the device 100 as mentioned above, because the anchor 120 isattached to the pull strings 174 in the illustrated embodiment, theanchor 120 is nonremovable from the device 100 to ease handling of thedevice 100. Similarly, the segments 134 can be modular as discussedabove and as illustrated in FIG. 25 such that any number of segments 134can be attached together to form the cannula 114.

The pull strings 174 can be configured to be individually manipulatedand/or to be manipulated two or more at a time. The pull strings 174 canalso be configured to adjust the cannula's longitudinal length and/or tobend the cannula 114. Pulling at least one of the pull strings 174 in aproximal direction can pull the anchor 120 in a proximal direction,thereby compressing the cannula 114 to reduce its longitudinal length.If less than a total number of the pull strings 174 are pulled in aproximal direction, the cannula 114 can bend, similar to motion of amarionette. Flexible biasing elements 142 of the segments 134 andflexible biasing elements 146 of the anchor 120 can flex as discussedabove to allow movement of the segments 134 and the anchor 120 relativeto one another to adjust the cannula's longitudinal length and/or thecannula's curvature.

The device 100 can include a locking mechanism configured to lock thepull strings 174 in position to hold the cannula 114 in a desiredconfiguration. The locking mechanism can have a variety of sizes,shapes, and configurations. In the illustrated embodiment, the lockingmechanism includes a plurality of key holes 180 formed in a proximalsurface 178 of the housing 112. Each of the key holes 180 can beconfigured to receive one of the pull strings 174 and to selectivelyallow and prevent free passage of its associated pull string 174.Although a number of key holes 180 in the illustrated embodiment equalsa number of pull strings 174, any one or more of the key holes 180 canbe configured to receive and lock two or more pull strings 174 such thatthe device 100 includes fewer key holes 180 than pull strings 174. Thekey holes 180 each include an opening formed in the housing's proximalsurface having a wide portion and a narrow portion, although they canhave a variety of sizes, shapes, and configurations. The wide portioncan have a diameter wider than a diameter of its associated pull string174 to allow free slidable movement of a pull string therein, while thenarrow portion can have a diameter narrower than the diameter of itsassociated pull string 174 to lock the pull string 174 in positiontherein. Each of the proximal terminal ends 174 p of the pull strings174 can have a diameter larger than its associated key hole wideportion's diameter, e.g., by being knotted, including an end cap,including an aglet, etc. In this way, the pull strings 174 can beprevented from slipping through the key holes 180 and into a workingchannel 116 of the device 100 where they cannot be as easilymanipulated.

FIG. 27 illustrates a sleeve 170 disposed around the cannula 114 of FIG.25. The sleeve 170 can have a variety of sizes, shapes, andconfigurations, but can as shown include a fluid-impermeable flexiblemember disposed over an external surface of the cannula 114 tofacilitate sealing of the cannula 114 and facilitate insertion andremoval of the cannula 114 from tissue. The sleeve 170 in theillustrated embodiment is adhered to external surfaces of each of thesegments 134 using a glue or other adhesive, but as will be appreciatedby a person skilled in the art, the sleeve 170 can be attached to thecannula 114 in any number of ways, e.g., through a tight cling fit. Thesleeve 170 can optionally be positioned within a tissue openingseparately from the cannula 114, and the cannula 114 can be insertedinto sleeve 170 already positioned in the tissue opening. A proximalportion of the sleeve 170 can be trimmed to reflect removal of anysegments 134 from a proximal end of the cannula 114 and reduce chancesof the sleeve 170 interfering with the housing 112 and/or the surgicalwork space. The sleeve 170 can be a continuous member extending alongthe cannula 114, as shown in FIG. 27, or the sleeve 170 can include aplurality of discrete members.

FIGS. 28 and 29 illustrate one exemplary embodiment of a surgical accessdevice 500 including a housing 512 with a cannula 514 distally extendingtherefrom and having a protective sleeve formed of a plurality ofdiscrete members 570 disposed therearound. The device 500 can beconfigured and used similar to the device 100 and can have an adjustablelongitudinal length. A surgical instrument 519 is shown in FIG. 28disposed through a working channel 516 defined by the housing 512 andthe cannula 514.

The sleeve members 570 forming the sleeve can have a variety of sizes,shapes, and configurations and can be attached to the cannula 514 in anyway. In the illustrated embodiment, the sleeve members 570 areconfigured as tape and include elongate strips coupled together using anadhesive such as biocompatible glue. Each of the sleeve members 570 canbe adhered to at least one adjacent sleeve member 570 such that thesleeve members 570 overlap to collectively form a continuous sleeve.

The cannula 514 can include a plurality of removably and pivotablycoupled segments 534 connected together by snap fit with an anchor 520removably and pivotably connected by snap fit to a distal-most one ofthe segments 534. Thus, the device's longitudinal length can be adjustedby selectively removing and adding segments 534 to the cannula 520. Thesegments 534 can include mating features, e.g., male and female members536, 532, configured to allow the adjacent segments to pivot relative toone another to allow the cannula 514 to bend, as shown in FIG. 28. Eachof the segments 534 can include at least one slot 537 extendingproximally from a distal end of the segment 534 along a partiallongitudinal length of the segment 534. The segments 534 each includefour slots, but the segments 534 can include any number of slots 537.The slots 537 can facilitate bending of the cannula 514 when a malemember 536 of one of the segments 534 pivots within the female member532 of an adjacent segment 534. Because the segments 534 have the slots537 formed through sidewalls thereof, the segments 534 in theillustrated embodiment are not connected together with a fluid-tightseal. The sleeve disposed around the cannula 514 can thus be configuredto provide a fluid-tight seal of the cannula 514.

FIG. 30 illustrates another embodiment of a cannula 614 including aplurality of segments 634 coupled together by snap fit and having acontinuous sleeve disposed therearound and formed from a plurality ofdiscrete sleeve members 670. The cannula 614 and the sleeve members 670can be configured and used similar to the cannula 514 and the sleevemembers 570 of FIGS. 28 and 29 discussed above, but the segments 634 inthe embodiment of FIG. 30, also illustrated in FIG. 31 as independentelements, include flexible biasing elements 642 configured to allowadjustment of the cannula's longitudinal length. The biasing elements642 can be configured and used similar to the biasing elements 42 ofFIG. 2 discussed above. In the illustrated embodiment, the biasingelements 642 include compressible coils or springs biased to a default,compressed configuration to thereby bias the cannula 614 to a compressedconfiguration. The biasing elements 642 can, as shown in FIGS. 30 and31, be coiled around an external surface of necks of their respectivesegments 634 and be configured to be contained within a female member632 of an adjacent segment 634.

In another exemplary embodiment, a segment's biasing element can bedisposed outside an adjacent segment rather than being contained withinthe adjacent segment's distal cavity as in the embodiments illustratedin FIGS. 2 and 30. In one exemplary embodiment illustrated in FIGS. 32and 33, a cannula 714 can include a plurality of segments 734 movablycoupled together that can be configured and used similar to the segments34 of FIG. 2. However, the segments 734 of FIGS. 32 and 33 each have aflexion region 742 such that the segments 734, when coupled together toform the cannula 714, can be movable toward and away from one anotheralong a longitudinal axis A4 of the cannula's working channel 716 toallow a length of the cannula 714 to be adjusted. The flexion regions742 can have a variety of sizes, shapes, and configurations, e.g., abellows (as shown in FIGS. 32 and 33), nested folds, a weakened region,etc., and can generally be configured to expand and compress uponapplication of a force, e.g., when curved through tissue, when anobturator coupled to an anchor (not shown) coupled to a distal-most oneof the segments 734 is manipulated as discussed above, etc. Because theflexion regions 742 can be configured to be flex to allow the cannula714 to bend and to adjust in length, and because the flexion regions 742can be disposed outside adjacent segments 734 when the segments 734 arecoupled together, male members 736 configured to be received in femalemembers 732 of adjacent segments 734 can be non-movably and/ornon-removably seated therein, which can help provide a fluid-tight sealbetween adjacent segments 734 such that the working channel 716 can befluid tight.

Optionally, an anchor can be coupled to a distal-most one of thesegments 734. FIGS. 34 and 35 illustrate an exemplary embodiment of ananchor 720 having a bulb shape and being configured to be coupled to thedistal-most one of the segments 734. However, as mentioned above and aswill be appreciated by a person skilled in the art, any of the anchorsdiscussed herein, including the anchor 720, can be configured to coupleto any cannula described herein. The anchor 720 can be configured andused similar to the anchor 20 of FIGS. 1 and 2, but the anchor 720 inthe illustrated embodiment includes a flexion region 746 (obscured inFIG. 35) similar to the flexion regions 742 of the segments 734. Theanchor 720 can also include at least one thread 721, e.g., two threadsas illustrated in FIGS. 34 and 35, spiraling around an exterior surfacethereof The threads 721 can have a variety of sizes, shapes, andconfigurations, as will be appreciated by a person skilled in the art.The threads 721 can be configured to engage tissue and facilitateinsertion and retention of the anchor 720 therein. The anchor 720 canthus be configured to be at least partially disposed within tissue toattach a surgical access device including the anchor 720 to the tissue.

In use, the anchor 720 can be inserted through an opening in tissueuntil the anchor 720 is positioned within a body cavity underlying thetissue. Then, the anchor 720 can be moved proximally and rotated aboutits longitudinal axis to engage tissue distally facing the body cavityto dispose and retain the anchor 720 at least partially therein.

FIGS. 36-38 illustrate one exemplary embodiment of a deployment systemthat can be configured to position the cannula 714 within a tissueopening and to deploy the anchor 720 at the cannula's distal end.Similar to that discussed above regarding the obturator 18 and thedevice 10 of FIG. 1, an obturator 718 can be configured to be slidablydisposed through the cannula's working channel 716 with a proximalhandle 728 of the obturator 718 being located proximal to a proximal endof the cannula 714 and with a distal tip 730 of the obturator 718extending distally beyond the anchor 720, as shown in FIG. 37. Theobturator's handle 728 can have a maximum diameter 728 d greater thanthe working channel's diameter 718 d at the working channel's proximalend to prevent the obturator 718 from being fully inserted into thecannula 714 through a proximal end thereof such that the obturator 718cannot be easily manipulated from outside a patient's body. Theobturator 718 can be configured as a bladed trocar such that obturator'sdistal tip 730 can include at least one slot 730 s, e.g., four slots,formed through a sidewall thereof and extending proximally from adistal-most end of the obturator 718. If the obturator 718 includes aplurality of slots 730 s as in the illustrated embodiment, the slots 730s can define a plurality of fingers 730 g that form the distal tip 730.The slots 730 s can be configured to allow radial expansion of theobturator's distal tip 730 in an outward direction. The obturator 718can be hollow and have an inner lumen 719 extending therethrough. Theinner lumen 719 can be configured to slidably receive a surgicalinstrument, such as an expander tool 731. At least a portion of theinner lumen 719, e.g., within the handle 728, can be threaded (notshown) to engage corresponding threads (not shown) on the expander 731.

The expander 731 can include a proximal handle 723 having a maximumdiameter 723 d greater than a diameter 719 d of the obturator's innerlumen 719 at the inner lumen's proximal end to prevent the expander 731from passing into the obturator 718 through a proximal end thereof suchthat the expander 731 cannot be easily manipulated. The expander 731 caninclude a tapered or conical distal tip 725. The expander 731 can beconfigured to be slidably inserted into the obturator's inner lumen 719such that the expander's distal tip 725 can be disposed at leastpartially within the obturator's distal tip 730 to radially expand theobturator's distal tip 730, as shown in FIG. 38. When the obturator'sdistal tip 730 is positioned within the anchor 720 such that at least aportion of the slots 730 and the fingers 730 g are positioned therein,and when the obturator 718 with the expander 731 positioned therein suchthat the expander's distal tip 725 radially expands the obturator'sdistal tip 730, as also shown in FIG. 38, outer surfaces of theobturator's fingers 730 g can grip an inner surface of the workingchannel 716 within the anchor 720 to thereby form a compression lockbetween the obturator 718 and the anchor 720. The anchor 720 can beconfigured to substantially not expand when the obturator's distal tip730 expands, e.g., by being formed of a substantially rigid materialand/or including a substantially rigid lining on its inner surfacefacing the working channel 716.

Locked to the anchor 720, the obturator 718 can be rotated, e.g., byrotating the handle 728, about a longitudinal axis of the obturator 718relative to the segments 734 of the cannula 714, and, if present, to ahousing (not shown) at a proximal end of the cannula 714, to therebyrotate the anchor 720. A mating feature of the anchor 720, e.g., a malemember 740, can be configured to be rotatably seated within a matingfeature, e.g., 738, of the distal-most segment 734 to allow the anchor720 to be rotated relative thereto. With the anchor 720 being disposedin a body cavity, rotating the anchor 720 in a proximal direction canrotate the anchor 720 into tissue to thereby secure the anchor 720therein. As mentioned above, the anchor's threads 721 can be configuredto help grip the tissue and securedly hold the anchor 720 therein. Theanchor 720 can be rotated any depth into the tissue, with the threads721 entirely or partially engaging the tissue. In an exemplaryembodiment, at least a distal-most end of the anchor 720 can remaindisposed in the body cavity when the anchor 720 is threaded into thetissue.

When the anchor 720 is threaded into tissue, the expander 731 can beremoved from the obturator's distal tip 730 such that the distal tip 730can radially collapse to release the compression lock between the anchor720 and the obturator 718. The expander 731 and the obturator 718 canthen be removed separately or together from the working channel 716 suchthat the working channel 716 can provide a pathway through tissue.

The anchor 720 can be removed from the tissue in a similar way to itsdisposal therein. The obturator 718 can be slidably disposed within theworking channel 716, and the expander 731 can be disposed within theobturator's inner lumen 719 and radially expand the obturator's distaltip 730 to form a compression lock between the anchor 720 and theobturator 718. Rotating the obturator 718 can correspondingly rotate theanchor 720 to rotate the anchor 720 out of the tissue. The obturator718, the expander 731, and the anchor 720 can then separately ortogether be removed from the patient's body.

FIGS. 39 and 40 illustrate another exemplary embodiment of a surgicalaccess device 400 including a manipulable adjustment mechanism in theform of a plurality of pull strings 474 configured to selectively adjusta longitudinal length of the device's cannula 414. As shown, the cannula414 can be formed of a plurality of modular segments 434 and have ananchor 420 at a distal end thereof In use, as shown in FIG. 39, anobturator 418 can be disposed in an inner lumen of the cannula 414, andthe cannula 414 with the obturator 418 disposed therethrough can bepositioned in an opening 471 in tissue 472 such that at least the anchor420 is positioned in a body cavity 473 underlying the tissue 472. Theobturator 418 can then be removed from the cannula 414, and one or moreexcess segments 434, one in the illustrated embodiment, can be removed,e.g., unsnapped, from a proximal end of the cannula 414, to reduce alongitudinal length of the cannula 414 as shown in FIG. 40. The pullstrings 474 extending through the cannula 414 and being connected to theanchor 420 can also be pulled in a proximal direction to further reducethe cannula's length by deploying the anchor 420 from a firstconfiguration, shown in FIG. 39, to a second configuration, shown inFIG. 40.

Either before or after the anchor 420 is deployed, a housing 412 can beattached to a proximal-most one of the segments 434 at a proximal end ofthe cannula 414. The housing 412 can be configured and used similar tothe housing 12 discussed above. In this way, the device 400 includingthe housing 412 and the cannula 414 can be secured within the tissueopening 471 such that one or more surgical instruments can be insertedtherethrough to access the body cavity 473.

In addition or in alternative to the pull strings being individually orcollectively pullable, the housing can be configured to rotate about alongitudinal axis of the device to move the pull strings. In this way,compression of tissue between the housing and the distal anchor can beadjusted any number of times during a surgical procedure to desirablysecure the surgical access device within an opening in the tissue.Rotating the housing in a first direction, e.g., clockwise, can move thepull strings in a proximal direction to shorten the cannula, androtating the housing in a second direction, e.g., counterclockwise, canmove the pull strings in a distal direction to lengthen the cannula. Thehousing can slidably move relative to the distal platform or seal.

FIGS. 41-43 illustrate an exemplary embodiment of a housing 212configured to rotate about a longitudinal axis A3 of the housing 212 tomove a plurality of pull strings 274 to adjust a longitudinal lengthand/or curvature of a cannula 214 distally extending from the housing212. Generally, the housing 212 can include upper and lower portions 212u, 212L with the upper portion 212 u being configured to rotate relativeto the lower portion 212L to adjust a length of the cannula 214. Theupper and lower portions 212 u, 212L can have a variety of sizes,shapes, and configurations. As illustrated, the lower portion 212L caninclude a base ring 296 and a distal platform or seal 282, and the upperportion 212 u can include a cap 294, a valve assembly ring 297 coupledto a proximal end of the cap 294 and configured to attach to a proximalhousing (not shown), and a retention ring 299 held by interference fitand positioned between the valve assembly ring 297 and the cap 294. Thepull strings 294 can extend through holes 295 in the retention ring 299and be secured therein similar to that described above regarding thenarrow portions of the key holes 180 of FIGS. 25 and 26. The pullstrings 294 can otherwise extend through central lumens of the base ring296, the distal platform or seal 282, the cap 294, and the valveassembly ring 297. In this way, rotation of the upper portion 212 u ofthe housing 212 relative to the housing's lower portion 212L and to thecannula 214 can similarly rotate the pull strings 274 relative to thehousing's lower portion 212L and the cannula 214 to adjust the cannula'slongitudinal length.

The upper and lower portions 212 u, 212L of the housing 212 can berotatably coupled to one another in a variety of ways. As shown, thebase ring 296 can include a proximally-extending grip ring post 293configured to engage a grip ring 291 distally extending from the cap294. The grip ring 291 can include a continuous circumferential ring asin the illustrated embodiment, or the grip ring 291 can include aplurality of distally extending posts similar to theproximally-extending anchor posts or clips 60 discussed above. The gripring 291 can be slidably mated to the grip ring post 293 with a radiallyextending protrusion of the grip ring 291 engaging the grip ring post293 as shown in FIG. 42.

The base ring 296 can include a plurality of ratchet ramps 284 eachhaving a plurality of detents 286 formed thereon. The cap 294 caninclude a plurality of distally-extending pawls 288 configured to engagethe detents 286 such that rotation of the housing's upper portion 212 uabout the housing's longitudinal axis A3 relative to the housing's lowerportion 296 and to the cannula 214 will cause the pawls 288 tosequentially engage their corresponding teeth 286. Although the housing212 in the illustrated embodiment includes four ramps 284 and fourcorresponding pawls 288, a person skilled in the art will appreciatethat the housing 212 can include any number of ramps and pawls.Similarly, each of the ramps 284 can slant at any angle and can includeany number of detents 286, e.g., twenty detents. The detents 286 can beconfigured to prevent rotation of a pawl 288 seated within one of thedetents 286. In this way, each detent 286 on a ramp 284 can beconfigured to define an incrementally locked, predetermined position ofthe housing 212. Each of the predetermined positions can correspond to alongitudinal length of the cannula 214 through which the pull strings274 longitudinally extend. In other words, when the housing's upperportion 212 u is rotated in a first direction, the pawls 288 moveproximally or up the slanted ramps 284, the pull strings 274correspondingly move proximally or up, thereby decreasing a longitudinallength of the cannula 214. Similarly, when the housing's upper portion212 u is rotated in a second, opposite direction, the pawls 288 movedistally or down the slanted ramps 284, the pull strings 274correspondingly move distally or down, thereby increasing a longitudinallength of the cannula 214. In the illustrated embodiment, rotating thehousing's upper portion 212 u in a clockwise direction shortens thecannula 214, but a person skilled in the art will appreciate that thehousing 212 can be configured such that clockwise rotation of thehousing's upper portion 212 u lengthens the cannula 214.

A proximal-most or highest end of the ramps 284 can each include a stop290 that has a size configured to prevent further proximal movement ofits associated pawl 288, e.g., when the pawl 288 abuts an inner surface290i of the stop 290. The stops 290 can also each be configured toprevent further distal movement of an adjacent one of the pawls 288,e.g., when the adjacent pawl 288 abuts an outer surface 290t of the stop290.

When the cannula 294 has been adjusted to a desirable longitudinallength, a proximal housing (not shown but which can be configured andused similar to the housing 12 of FIGS. 1 and 2) including at least oneseal element configured to form at least one of an instrument seal and achannel seal can be snapped onto or otherwise attached to the valveassembly ring 297. Excess lengths of the pull strings 274 can optionallybe trimmed before attachment of the proximal housing to reduceinterference of the pull strings 274 with the proximal housing.

As mentioned above, a surgical access device need not include a distalanchor, and such a device can include pull strings configured to adjusta longitudinal length of the device's cannula. Rotation of a housingfrom which the cannula distally extends can be configured to so adjustthe cannula's longitudinal length similar to that discussed aboveregarding FIGS. 41-43. In one exemplary embodiment shown in FIG. 44, asurgical access device 300 includes a housing 312 having upper and lowerportions 312 u, 312L with a cannula 314 distally extending from thehousing 312 and including a plurality of segments 334. Each of thesegments 334 in the embodiment shown in FIG. 44 have acylindrically-shaped distal portion. A plurality of pull strings 374extending through the housing 312 and the cannula 314 can have proximalterminal ends 374 p located proximal to the housing 312 and distalterminal ends 374 d located distal to a distal-most one of the segments374. The terminal ends 374 p, 374 d are secured in their respectivepositions using respective aglets 375 p, 375 d. In this way, thehousing's upper portion 312 u can be selectively rotated relative to thehousing's lower portion 312L and the cannula 314, such that the pullstrings 374 can compress the segments 374 to shorten a length of thecannula 314 or relax the segments 374 to lengthen the cannula 314.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination,e.g., a housing, a cannula segment, an anchor, etc. Upon cleaning and/orreplacement of particular parts, the device can be reassembled forsubsequent use either at a reconditioning facility, or by a surgicalteam immediately prior to a surgical procedure. Those skilled in the artwill appreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A modular access device, comprising: a housinghaving a cannula extending distally therefrom, the housing and thecannula defining a working channel extending therethrough for receivingan instrument; at least one seal element disposed within the workingchannel and configured to form at least one of a seal around aninstrument disposed through the working channel and a seal across theworking channel when no instrument is disposed therethrough; and ananchor segment removably coupled to a distal end of the cannula, theanchor segment having a plurality of flexible wires extending between aproximal portion of the anchor segment and a distal portion of theanchor segment, the plurality of flexible wires being spacedlongitudinally apart from one another and extending along a spiralbetween the proximal portion and the distal portion.
 2. The modularaccess device of claim 1, wherein the anchor segment has a maximum outerdiameter that is greater than a maximum outer diameter of the cannula.3. The modular access device of claim 1, wherein the anchor segment ismovable between a first configuration in which the anchor segment has afirst outer diameter and a second configuration in which the anchorsegment has a second outer diameter that is greater than the first outerdiameter.
 4. The modular access device of claim 3, wherein the anchorsegment is configured to move between the first configuration and thesecond configuration upon rotation of the distal portion of the anchorsegment.
 5. The modular access system of claim 4, wherein rotation ofthe distal portion of the anchor segment comprises rotation of thedistal portion relative to the proximal portion in a plane substantiallyperpendicular to a longitudinal axis of the cannula.
 6. The modularaccess device of claim 3, further comprising an engagement featureformed within the anchor segment and configured to couple to acomplementary engagement feature on an obturator.
 7. The modular accessdevice of claim 3, wherein at least a portion of the anchor segment isconfigured to collapse when the anchor segment moves from the firstconfiguration to the second configuration.
 8. The modular access deviceof claim 3, wherein the plurality of flexible wires are configured tocollapse when the anchor segment moves from the first configuration tothe second configuration.
 9. The modular access device of claim 1,further comprising a sleeve disposed over the plurality of flexiblewires.
 10. The modular access device of claim 1, wherein the cannula isformed from a plurality of segments.
 11. The modular access device ofclaim 10, wherein the plurality of segments are polyaxially coupled toone another.
 12. A modular access system, comprising: a housingconfigured to be positioned above an outer surface of a tissue; acannula extending distally from the housing and configured to extendthrough an opening in the tissue; a plurality of anchors of differingconfigurations, each anchor being removably matable to a distal end ofthe cannula, and each anchor being movable between a first configurationin which the anchor has a first outer diameter and a secondconfiguration in which the anchor has a second outer diameter that isgreater than the first outer diameter; and an obturator that isdisposable through the housing and the cannula, the obturator having afirst engagement feature formed on an outer sidewall thereof that isconfigured to engage a second engagement feature formed on an innersurface of one of the plurality of anchors such that when the firstengagement feature engages the second engagement feature and theobturator is rotated about a longitudinal axis of the obturator, therotation causes the anchor to move from the first configuration to thesecond configuration.
 13. The modular access system of claim 12, furthercomprising at least one seal disposed within at least one of the housingand the cannula, the at least one seal being configured to form at leastone of a seal around an instrument disposed through the access deviceand a seal within the access device when no instrument is disposedtherethrough.
 14. The modular access system of claim 12, wherein theobturator has a transparent distal tip.
 15. The modular access system ofclaim 12, wherein the cannula is formed from a plurality of segments.16. The modular access system of claim 12, wherein one of the first andsecond engagement features comprises a pin and another one of the firstand second engagement features comprises a slot, the pin beingconfigured to travel within the slot when the obturator ir rotated aboutthe longitudinal axis.